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Application Form For Bharatnatyam Exam: Total Two Pages of The Form - Page - 1

The document is an application form for students wishing to take a Prarambhik/Basic level Bharatnatyam exam conducted by MADHYAM NON-PROFIT CHARITY ORGANIZATION. The 2-page form requests information from the student and teacher, including names, addresses, birthdate, and contact information. It also includes undertakings that must be signed by both the student and teacher agreeing to follow the rules and regulations of the exam. If accepted, the second page provides a hall ticket allowing the student to take the exam and includes a report slip for the examiner to record results.

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Ram Manohar Sah
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888 views2 pages

Application Form For Bharatnatyam Exam: Total Two Pages of The Form - Page - 1

The document is an application form for students wishing to take a Prarambhik/Basic level Bharatnatyam exam conducted by MADHYAM NON-PROFIT CHARITY ORGANIZATION. The 2-page form requests information from the student and teacher, including names, addresses, birthdate, and contact information. It also includes undertakings that must be signed by both the student and teacher agreeing to follow the rules and regulations of the exam. If accepted, the second page provides a hall ticket allowing the student to take the exam and includes a report slip for the examiner to record results.

Uploaded by

Ram Manohar Sah
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Managed by MADHYAM NON–PROFIT CHARITY ORGANIZATION

Application form for Bharatnatyam Exam Picture


Total two pages of the form – Page - 1

Sir,

I wish to appear for the Prarambhik/Basic level examination conducted by SCICMD in April / Nov.20 - -.

Detailed information of the candidate:

1. Name: -------------------- ------------------------- --------------------------------


(First) (Middle) (Last/Surname)
Note: Write your name exactly the way you want it to appear on the Certificate.

2. Mailing Address : ----------------------------------, ---------------------------, ------------------------------.


(Street Name & number) (City) (State – Zip code)

3. Email Address : ------------------------------------------ 4. Phone contact: (Home) ---------------- ---------------

5. Phone contact Cell: ------------- ---------- ------------- 6.. Student’s DOB : ---------- --------- ----------
(Month) (Day) (Year)

6. Teacher/ Guru’s Name: ----------------------------------------------

7. Teacher/Guru’s Email contact: ------------------------------------

Teacher/Guru’s permission:
I hereby give my permission to my student/disciple Mr/Ms. --------------------------------- -------------------
to take this examination. I undertake that I have taught complete curriculum to my student.

Signature of teacher/Guru Seal/Stamp of the institute

----------------------------------- -----------------------------------

Undertaking of the candidate:


I hereby agree to follow all the rules and regulations of the institute in this regard.
All the information provided in this form is correct. I have enclosed the form fee by check # ------

Sincerely Date: --------------------------

-------------------------------
(Signature of the student)

Make your check payable to MADHYAM. (Take print out of this application form, sign it, put your pictures in
all three boxes and mail the form to following address: MADHYAM: 17 Mattawang Drive, Somerset, NJ 08873.
Managed by MADHYAM NON–PROFIT CHARITY ORGANIZATION

Hall ticket for Prarambhik/Basic Bharatnatyam Exam Picture


Total two pages of the form – Page - 2

Student’s Entry ticket to examination room.

Mr/Ms (Student’s name) : ------------------------- ------------------------------------------ is allowed to take

Prarambhik/Basic level exam in Bharatnatyam in April/ Nov. 20 - - exam session.

Student’s Roll Number : ---------------- Student’s signature : ---------------------------


(For office use only) (student should sign here at the time of filling the form)

Cut Here
Upper part to be given students and Lower part to be given to the practical examiner by the coordinator.

Managed by MADHYAM NON–PROFIT CHARITY ORGANIZATION

Practical Examiner’s Report slip- Picture


Prarambhik/Basic-Bharatnatyam:

Sir,
I hereby certify that I have conducted Prarambhik/Basic level Exam

in Bharatnatyam of Mr/Ms----------------------------------------------- as per the rule.

Student’s Roll # ---------------------


(For office use only)

Name of Examiner : ---------------- ------------------------- Date of Exam ------------- ------------

Signature of Examiner Student’s Signature

-------------------------------------- -----------------------------------------------
(Student will sign on the above line at the time of practical exam)

Examiner should send all the report slips to the Institute along with result sheet.

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